*Purpose: There is belief that the discard rates are higher for organs turned down late in the recovery process. The expedited liver (LI) pathway, allows for an optional placement process for LIs that were turned down after entering the operating room. The policy sought to improve system efficiency and clarity on the yield of these LIs. The evaluation of the use of the expedited pathway in these events can help to improve the LI recovery and transplant system.

*Methods: Summary statistics regarding LI offer records where acceptances were changed to refusals within 12 hours of cross clamp and LI discard rates are stratified by pre- (09/15/20 – 3/25/21) and post-policy (03/25/21 – 10/01/21) eras based on cross clamp date and placement process, using the OPTN data on offers and deceased donors LIs recovered with the intent to transplant.

*Results: The percent of LI refusals within 12 hours of cross clamp out of all deceased donor LIs increased from pre- to post-policy era (Pre: 1110 (22.9%), Post: 1304 (25.3%)). Only 15.0% of the turndowns in the post era utilized the expedited pathway. It was most often used within 3 hours after cross clamp (52.6%), when the frequency of turn down events after cross clamp was highest for both eras (Pre: 24.6%, Post: 25.8%) (Figure 1A). The discard rate for LIs refused within 12 hours prior to cross clamp was 12.6%, while LIs refused within 12 hours after cross clamp had a discard rate of 52.4%, both higher than the discard rate of 3.5% seen for LIs with no turndowns (Figure 1B). The trend in the discard rates is similar to the trend in the proportion of turndowns seen after cross clamp, and was highest for LIs refused within 3 hours after clamp in both eras (Pre: 52.0%, Post: 60.0%) (Figure 1B).

*Conclusions: The expedited pathway has not been widely utilized. The data, particularly timestamps of offer refusal events, are limited to the accuracy of what is reported to the OPTN; however, there is a strong indication that discard rates are higher for late turndowns that occur after cross clamp. Low utilization of the expedited pathway contributes no clear impact to the discard rate. Increased use of the pathway may lead to better results.

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